title: Prescription coverage in indigent patients affects the use of long-acting opioids in the management of cancer pain.
abstract: OBJECTIVE
  We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain.
  
  
  METHODS
  We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations.
  
  
  RESULTS
  There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups.
  
  
  CONCLUSIONS
  Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients.
authors.affiliation: Department of Medicine and the New Jersey Medical School Cancer Center, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Wieder
authors.forename: Nila
authors.initials: N
authors.lastname: Delarosa
authors.forename: Margarette
authors.initials: M
authors.lastname: Bryan
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Hill
authors.forename: William J
authors.initials: WJ
authors.lastname: Amadio
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D059350:Chronic Pain / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D004363:Drug Utilization; D005006:Ethnicity; D005260:Female; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid; D008489:Medical Indigency; D055118:Medication Adherence; D008875:Middle Aged; D008913:Minority Groups; D009294:Narcotics / Q000191:economics / Q000627:therapeutic use*; D009369:Neoplasms / Q000503:physiopathology* / Q000628:therapy; D009515:New Jersey / Q000453:epidemiology; D059408:Pain Management / Q000191:economics*; D010147:Pain Measurement; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States; D014505:Urban Population
chemical_list: D003692:Delayed-Action Preparations; D009294:Narcotics
keywords: Analgesic; Cancer Pain; Disparities; Ethnic; Indigent; Narcotics; Pain Management; Racial